Cheryl Manchenton, RN, explains CMS’ Hospital-Acquired Condition Reduction Program (HACRP) and says inpatient coding professionals can play a significant role in HACRP success by understanding the basis for hospital-acquired condition scores and ensuring that documentation and coding accurately and fully captures patient conditions and complications.
Sepsis is a leading cause of death in U.S. hospitals, but in most of cases, sepsis alone may not be the true cause of the majority of inpatient, septic hospital deaths, according to recent research published by the Journal of the American Medical Association.
Q: I know that the tumor, nodes, and metastasis (TNM) staging system can be used for ICD-10-CM coding purposes, but I’ve never used it before. As an inpatient coding professional, should I know how this system works and how to apply it?
A transcatheter aortic valve replacement (TAVR) is an interventional cardiology procedure that has proven to be an important life-saving cardiac intervention frequently seen by inpatient coders. In this article, Stephen Houlahan, RN, MSN, MBA, CCDS, reviews TAVR history, clinical background, and documentation and reimbursement methodologies to ensure proper education and compliance for facilities.
Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, writes that proper reporting and documentation of chronic obstructive pulmonary disease (COPD) will help ensure accurate MS-DRG assignment and strengthen cases during inpatient audits. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
With March declared National Endometriosis Awareness Month, Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, HCS-D, details endometriosis-related procedure reporting for inpatient coders. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
During CMS’ two-day Coordination and Maintenance Committee meeting March 5 and 6, various stakeholders presented ICD-10-PCS proposals for consideration for future ICD-10-PCS code updates.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS, reviews the clinical validation of acute congestive heart failure (CHF) exacerbation and shares his hospital’s coding and documentation strategy to help in appeal battles.
Adriane Martin, DO, FACOS, CCDS, details the updates found in the 2019 ACDIS/AHIMA “Guidelines for Achieving a Compliant Query Practice” and writes that thorough knowledge of query guidelines is essential for inpatient coders and staying abreast of these guideline updates is crucial.
Laurie L. Prescott, MSN, RN, CCDS, CDIP , details the basics of ICD-10-CM/PCS for newer inpatient coders including a review of the ICD-10-CM seventh-character extension, placeholder use, and ICD-10-PCS root operations. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Q: We had a patient with hemorrhagic cystitis. Our preprocedural plan was a cystoscopy with a bladder biopsy and cauterization. How should this be reported in ICD-10-PCS? We are having trouble choosing between Control or another root operation, and we are getting different MS-DRGs depending how the procedure is reported.
A recent study showed that CMS’ Hospital Readmissions Reduction Program (HRRP) may be causing an increase in the 30-day mortality rate for certain conditions. Now, a second study published by Health Affairs claims that the reductions in readmission rates are themselves “illusory or overstated.”
The benefits outweigh the difficulties when it comes to retrospective reviews. How do you get started with this new venture? Like many aspects of CDI, there are many ways to approach the problem. This article details these approaches, including how to enhance coder and CDI collaboration for these reviews.
Not many clinical conditions cause more consternation for inpatient coders and CDI specialists than acute and chronic respiratory failure. In this article, William E. Haik, MD, FCCP, CDIP, details acute and chronic respiratory failure and the critical elements in the health record that validate their reporting.
CMS recently released an MLN Matters article to inform hospitals and Medicare Administrator Contractors of new system changes, effective July 1, that ensure organ acquisition costs are not included in the IPPS payment calculation for claims that group to a non-transplant MS-DRG.
CDI professionals can improve documentation and data scores via a mortality review process. This article discusses the various types of mortality reviews and publicly reported data and gives tips on how to implement a successful mortality review process.
Joe Rivet, JD, CCS-P, CPC, CEMC, CHC, CCEP, CHRC, CHPC, CICA, CPMA, CAC, CACO, explains that reporting sepsis has long been a challenge for many coders even with the continual release of Coding Clinics and guideline revisions. In this article, Rivet reviews common coding traps for this condition including reporting urosepsis, severe sepsis, and sepsis on admission.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP, reviews ICD-10-CM/PCS cardiac coding for American Heart Month and writes that since accurate coding improves data quality for these conditions, which in turn is used for statistics and tracking trends, ensuring the disease process is captured correctly is imperative. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Using financial penalties to reduce hospital readmissions has been linked to a significant rise in post-discharge mortality for patients with heart failure and pneumonia, according to a recent study by the Journal of the American Medical Association.
Q: What is the difference between ICD-10-CM code I24.8 (other forms of acute ischemic heart disease) and code I21.A1 (myocardial infarction type 2)? In which situation would each of these codes be reported?
Julian Everett, BSN, RN, CDIP, details her experience reviewing pediatric mortality cases for the first time and gives tips on how the different revenue cycle departments can work together to improve their processes and outcomes.
Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, HCS-D, reviews Coding Clinic , Fourth Quarter 2018, advice surrounding body mass index reporting and how new advice conflicts with previous guidance. McCall also reviews payment methodologies and the official guideline updates for this condition. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Denise Wilson, RN, MS, RRT, and Karla Hiravi, RN, BSN, explore why coding and clinical denials for acute kidney injury (AKI) and acute tubular necrosis (ATN) are different and the importance of different appeal strategies.
Training new inpatient coders and CDI staff is a big job that often takes several months to conclude, but the end of orientation doesn’t mean that staff members never have to undergo education ever again. As most are keenly aware, the ground is always moving under our feet. From new regulations, to coding guideline changes, to new clinical definitions, education never truly ends.
Q: I would like to add encephalopathy due to urinary tract infection to our quick coding tips, but our CDI specialists disagree on how this condition should be coded and want us to query for metabolic encephalopathy. How should this condition ultimately be reported?
The mechanics of the concurrent coding process can cause headaches for both CDI and coding professionals. Plus, one could argue that CDI’s presence itself limits the number of necessary post-discharge clarifications without the process of concurrent inpatient coding. This article reviews ways that CDI programs can get involved with this process and work collaboratively with coders.
Adriane Martin, DO, FACOS, CCDS, reviews Coding Clinic’s Third and Fourth Quarter 2018 advice including reporting for coronary artery bypass grafting, drainage of an abscess in the submandibular space, and diabetes. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Average hospital costs and mortality rates are significantly higher for patients diagnosed with sepsis after hospital admission when compared with patients diagnosed prior to admission, according to a retrospective analysis recently published in Critical Care Medicine.
This article reviews HCPro’s 2018 coding productivity survey and reviews data on factors that have affected coder productivity, remote coders, and collaboration between coders and CDI specialists, including charts coded per hour and coding accuracy standards.
Q: A physician documented that a pregnant patient is obese, and the patient’s chart has a listed body mass index (BMI) score. Can we assign an ICD-10-CM BMI code in this instance or should this never be done for an obstetrics patient?
The Office of Inspector General (OIG) has been conducting a series of studies about adverse events in various healthcare settings since 2008 and will be publishing more of its corresponding reports throughout 2019, the OIG said in a statement.
Assigning the appropriate ICD-10-PCS code for spinal procedures can be a challenge for inpatient coders as they need to correctly identify each character of the seven-character code. In this article, Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDS , offers coding tips for reporting spinal surgery cases in ICD-10-PCS and examines the correct use of each character. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS recently made several updates in its latest version of its Hierarchical Condition Category (HCC) list, including revisions to the mental health and chronic kidney disease categories. And, while HCCs may not be a common review focus for inpatient coders and CDI professionals, capturing HCCs for these conditions is paramount for accurate reporting and reimbursement.
Adriane Martin, DO, FACOS, CCDS, writes that with the complexity of malnutrition—and the complexity of updated criteria—even the most seasoned inpatient coder should review ICD-10-CM malnutrition coding guidelines and criteria frequently to ensure compliant reporting.
A preliminary study found that a new point-of-care troponin assay safely ruled out acute myocardial infarction (AMI) in a large proportion of patients with symptoms suggestive of acute coronary syndrome, according to the report published in the Journal of the American Medical Association.
The original DRG system aimed to categorize similar patients with theoretically similar treatments and charges based on the patient’s principal diagnosis and up to eight secondary diagnoses. As time has gone by this system has expanded and become more complicated, making it essential for inpatient coders to understand to ensure accurate reporting and facility reimbursement.
Q: Considering the fiscal year 2019 update to the ICD-10-PCS Official Guidelines for Coding and Reporting for Transfer procedures, how should we now report a pedicled transverse rectus abdominis myocutaneous (TRAM) flap procedure in ICD-10-PCS?
Sepsis has been notoriously hard to report in ICD-10-CM, which means coders should not only fully understand coding guidance and guidelines for sepsis, but they should also have a thorough knowledge of its clinical aspects as well. Cesar M. Limjoco, MD , breaks down these clinical aspects and sheds light on the various sepsis definitions coders have encountered over the years.
Adrienne Commeree, CPC, CPMA, CCS, CEMC, CPIP , writes that while reporting mental illness is on the radar for outpatient coders, inpatient coders should be up to date with these diagnoses as well. Capturing this data in the inpatient setting not only substantiates reimbursement, it is also used to identify national trends for tracking and understanding these serious conditions. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Richard Pinson, MD, FACP, CCS, and Cynthia Tang, RHIA, CCS, review the recently published “Global Leadership Initiative on Malnutrition (GLIM) Criteria for the Diagnosis of Malnutrition: A Consensus Report From the Global Clinical Nutrition Community” and help coders apply this criteria in ICD-10-CM.
As the task of query creation is becoming more prevalent in coding departments, reviewing essential query requirements is a must for all inpatient coders. This article covers these essential requirements including the growing adoption of electronic medical records, when to query, and pointers for submitting queries to physicians. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
CMS and the Office of Inspector General (OIG) claims to have identified unspecified upcoding in hospital billing—either accidentally or intentionally reporting higher severity codes than supported by documentation to increase payment. Because of this, these entities will conduct a two-part study to assess inpatient hospital billing, according to the OIG.
Sarah Humbert, RHIA, and Catrena Smith, CCS, CCS-P, CPCO, CPC, CIC, CPC-I, CRC, CHTS-PW, explore three scenarios for onboarding new inpatient coders and provide valuable advice to prepare them for success.
Trey La Charité, MD, FACP, SFHM, CCS, CCDS, writes that by reviewing common electronic health record (EHR) challenges, a CDI program can formulate appropriate mitigation strategies to minimize potential negatives of the system.
For patients who suffer from frequent symptoms of gastroesophageal reflux disease (GERD), the provider may have to increase to prescription strength medications and possibly consider surgical intervention for severe cases. In this article, Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, HCS-D, reviews ICD-10-CM/PCS coding for these GERD diagnoses and procedures. Note : To access this free article, make sure you first register here if you do not have a paid subscription.
Among patients ages 65 years and older, the rate of opioid-related hospitalizations increased more than the rate of nonopioid-related hospitalizations between 2010 and 2015, according to the recent statistical brief published by the Healthcare Cost and Utilization Project.